Secure Application

1. Configure Your PolicyEdit

Choose Your Profession

Select your main profession and add any additional modalities or disciplines you would like coverage for.

Add Additional Modalities
Add all the modalities and disciplines you need
coverage for.

Select all that apply. If you practice Yoga Therapy, you must select it as your professional or other discipline here.

Barber

Cosmetology

Esthetics

Massage

Movement

Nail Tech

Other

Pilates

Reflexology

Reiki

Teaching of Dance

Yoga Fit

Yoga Instruction

Yoga Therapy

Yoga Therapists Acknowledgement

* I represent the following:(1)I am a certified yoga therapist through the International Association of Yoga Therapists;(2) I provide a client information document to my clients explaining the nature and extent of the services being provided;(3) I understand and communicate to my clients that Yoga Therapy is not a licensed healthcare profession in the state or jurisdiction in which I practice.

Choose Your Insurance Plus Options

through XX/XX/XXXX

Select your insurance plus policy below.

Choose your program:

$159 Insurance Plus Professional Rate Per Year

$279.95 Insurance Plus Professional 2 Year (Save $48.05)

$25 Insurance Plus Student Rate Per Year

$39 Insurance Plus Benefits Only, Per Year (excludes insurance)

School Policy Requirements

Only students enrolled in their initial license or certification course for the profession selected as primary modality qualify for a student policy.

If you are not a student on the effective date of coverage, all insurance is null and void and no claims will be paid.

Our student policies will only cover the discipline you are in school for when your coverage begins.

School Name (Student policies only)

Add Additional Insureds

Add businesses or people protected by endorsement from the named insureds
negligence. This does not protect other practitioners. Cost per Additional
Insureds: $10 for 1 year and $15.95 for 2 year policy.

Unlimited Additional Insureds Package

Throughout the span of your policy, you may likely have to add additional insureds.
The cost of additional insureds can add up. Why not save this expense by purchasing the Unlimited Additional Insured Package?

$30 Unlimited Additional Insureds

Cost per Additional Insureds: $10 for 1 year and $15.95 for 2 year policy.

2. Your InformationEdit

Policy Holder Information

Please enter your name EXACTLY how it will appear on your
certificate of insurance. *All items marked with an asterisk are required fields.

You can to Facebook to fill out some fields for you.

Your free website will be available as soon as we process this
application.

Purchase Now and Get Coverage Immediately

Billing Address

Authorization and Disclosure

Estheticians Alliance membership will be effective upon the effective date entered
at the top of the form. Membership term is 12 or 24 months depending on your policy.

Estheticians Alliance is not responsible for discontinuing any payroll/credit
card allotment process you may have with any other Professional
Liability provider.

I represent that the above statements are true and no material facts have been suppressed
or misstated. As of this date, I have no knowledge of any allegation, claim or lawsuit or
any act, error or omission, which might reasonably be expected to result in a claim or
lawsuit. I further represent that, to the extent required, I am licensed to practice in
accordance with all relevant federal, state and local requirements and my license is
current and active. I understand and agree that I am covered for the modalities listed on
the Insurance Plus website only to the extent that they are included in the scope of work
as defined by the federal, state or local jurisdiction that regulates my professional
activities. I acknowledge that the Effective Date of coverage must be either the
application submission date or a future date. Applications cannot be submitted with an
Effective Date of coverage that precedes the date of application. In addition, I
acknowledge that professional services rendered under the influence of drugs or alcohol
are excluded from coverage. I understand that if I am practicing Yoga Therapy, I have
selected it as my profession or other discipline above.

Upon submission of this application, your policy becomes
effective on the date selected above. Your payment will be
reflected on your credit card statement this month.

I authorize coverage issuance and the above statement is true to the
best of my knowledge. I also understand that once this credit card
payment is processed, there is no cancellation, refund or partial refund
available.

PRIVACY POLICY: We respect and are committed to protecting your
privacy. We may collect personally identifiable information
when you visit our site. We also automatically receive and
record information on our server logs from your browser
including your IP address, cookie information and the page(s)
you visited. We will not sell your personally identifiable
information to anyone.

SECURITY POLICY: Your payment and personal information is
always safe. Our Secure Sockets Layer (SSL) software is the
industry standard and among the best software available today
for secure commerce transactions. It encrypts all of your
personal information, including credit card number, name, and
address, so that it cannot be read over the internet.

REFUND POLICY: This is a fully earned policy, once this credit
card payment is processed, there is no cancellation, refund or
partial refund available. Please call our Customer Service Team
with any questions.